title: Prevalence of prehospital hypoxemia and oxygen use in trauma patients.
abstract: OBJECTIVE
  This study estimates the prevalence of injured patients requiring prehospital supplemental oxygen based on existing recommendations, and determines whether actual use exceeds those recommendations.
  
  
  METHODS
  Prehospital oxygen use and continuous peripheral oxygen saturation measurements were prospectively collected on a purposive sample of injured civilians transported to an urban level 1 trauma center by paramedics. Structured chart review determined injury characteristics and outcomes. Supplemental oxygen administration indications were hypoxemia (peripheral oxygen saturation ≤ 90%), hemorrhagic shock (systolic blood pressure < 100 mmHg), or paramedic suspicion of traumatic brain injury.
  
  
  RESULTS
  Paramedics enrolled 224/290 screened subjects. Median (range) age was 34 (18-84) years, 48.7% were nonwhite, 75.4% were male, and Injury Severity Score was 5 (1-75). Half (54.5%) were admitted; 36.2% sustained a penetrating injury. None underwent prehospital endotracheal intubation. Hypoxemia occurred in 86 (38.4%), paramedics suspected traumatic brain injury in 22 (9.8%), and 20 (8.9%) were hypotensive. Any indication for supplemental oxygen (107/224 [47.8%, 95%CI 41.3%-54.3%]) and prehospital administration of oxygen (141/224 [62.9%, 95%CI 56.2%-69.2%]) was common. Many (35/141 [24.8%]) received oxygen without indication.
  
  
  CONCLUSIONS
  On the basis of current guidelines, less than half of adult trauma patients have an indication for prehospital supplemental oxygen, yet is frequently administered in the absence of clinical indication.
authors.affiliation: Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way ML0769, Cincinnati, OH 45267-0769.
authors.forename: Jason
authors.initials: J
authors.lastname: McMullan
authors.forename: Dario
authors.initials: D
authors.lastname: Rodriquez
authors.forename: Kimberly Ward
authors.initials: KW
authors.lastname: Hart
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.forename: Kay
authors.initials: K
authors.lastname: Vonderschmidt
authors.forename: Beth
authors.initials: B
authors.lastname: Wayne
authors.forename: Richard
authors.initials: R
authors.lastname: Branson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000628:therapy; D004632:Emergency Medical Services; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007022:Hypotension / Q000628:therapy; D000860:Hypoxia / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult